Ranjith Jayaraman1, Rosemol Varghese2, Jones Lionel Kumar3, Ayyanraj Neeravi4, Devika Shanmugasundaram5, Ravikar Ralph6, Kurien Thomas7, Balaji Veeraraghavan8. 1. Department of Clinical Microbiology, Christian Medical College and Hospital, Vellore 632004, India. Electronic address: ranjithcmc@gmail.com. 2. Department of Clinical Microbiology, Christian Medical College and Hospital, Vellore 632004, India. Electronic address: rosemol.varghese@gmail.com. 3. Department of Clinical Microbiology, Christian Medical College and Hospital, Vellore 632004, India. Electronic address: jonedany1208@gmail.com. 4. Department of Clinical Microbiology, Christian Medical College and Hospital, Vellore 632004, India. Electronic address: ayyanmicro@gmail.com. 5. Department of Biostatistics, National Institute for Research in Environmental Health (ICMR), Bhopal 462001, India. Electronic address: devika.cmc@gmail.com. 6. Department of General Medicine, Christian Medical College and Hospital, Vellore 632004, India. Electronic address: ravikar_ralph@yahoo.com. 7. Department of General Medicine, Christian Medical College and Hospital, Vellore 632004, India. Electronic address: kurien123@gmail.com. 8. Department of Clinical Microbiology, Christian Medical College and Hospital, Vellore 632004, India. Electronic address: vbalaji@cmcvellore.ac.in.
Abstract
PURPOSE: To investigate the epidemiology of invasive pneumococcal disease (IPD), prevalent serotypes, and pattern of antimicrobial resistance (AMR) in Indian adults. METHODS: Prospective laboratory based surveillance of IPD was carried out in >18 years age group between January 2007 and July 2017, from a tertiary care hospital in South India. All Streptococcus pneumoniae culture positives from blood, CSF and sterile body fluids were characterized to identify the serotypes and AMR. RESULTS: A total of 408 IPD cases were characterized in this study. The overall case fatality rate in this study was 17.8% (95% confidence interval (CI): 14.1, 22.4). Pneumonia (39%), meningitis (24.3%), and septicaemia (18.4%) were the most common clinical conditions associated with IPD. Serotypes 1, 3, 5, 19F, 8, 14, 23F, 4, 19A and 6B were the predominant serotypes in this study. Penicillin non-susceptibility was low with 6.4% CONCLUSION: Serotype data from this study helped in accurate estimation of pneumococcal conjugate vaccine-13 and pneumococcal polysaccharide vaccine-23 protective coverage against serotypes causing IPD in India as 58.7% (95% CI: 53.8, 63.4) and 67.4% (95% CI: 62.7, 71.8) respectively. Penicillin non-susceptibility in meningeal IPD cases is 27.4%. Empirical therapy for meningeal IPD must be cephalosporin in combination with vancomycin since cefotaxime non-susceptibility in meningeal IPD is 9.9.
PURPOSE: To investigate the epidemiology of invasive pneumococcal disease (IPD), prevalent serotypes, and pattern of antimicrobial resistance (AMR) in Indian adults. METHODS: Prospective laboratory based surveillance of IPD was carried out in >18 years age group between January 2007 and July 2017, from a tertiary care hospital in South India. All Streptococcus pneumoniae culture positives from blood, CSF and sterile body fluids were characterized to identify the serotypes and AMR. RESULTS: A total of 408 IPD cases were characterized in this study. The overall case fatality rate in this study was 17.8% (95% confidence interval (CI): 14.1, 22.4). Pneumonia (39%), meningitis (24.3%), and septicaemia (18.4%) were the most common clinical conditions associated with IPD. Serotypes 1, 3, 5, 19F, 8, 14, 23F, 4, 19A and 6B were the predominant serotypes in this study. Penicillin non-susceptibility was low with 6.4% CONCLUSION: Serotype data from this study helped in accurate estimation of pneumococcal conjugate vaccine-13 and pneumococcalpolysaccharide vaccine-23 protective coverage against serotypes causing IPD in India as 58.7% (95% CI: 53.8, 63.4) and 67.4% (95% CI: 62.7, 71.8) respectively. Penicillin non-susceptibility in meningeal IPD cases is 27.4%. Empirical therapy for meningeal IPD must be cephalosporin in combination with vancomycin since cefotaxime non-susceptibility in meningeal IPD is 9.9.
Authors: Parvaiz A Koul; Subramanium Swaminathan; Thirumalai Rajgopal; V Ramsubramanian; Bobby Joseph; Shrinivas Shanbhag; Ashish Mishra; Sidram K Raut Journal: Indian J Occup Environ Med Date: 2020-03-18